Palliative Care a Boost for Parkinson Disease Patients

Benzi M. Kluger, MD

A care plan that addresses both the physical and mental symptoms of Parkinson disease could be beneficial for patients and caregivers alike.

A team of investigators, led by Benzi M. Kluger, MD, Department of Neurology, Anschutz Medical Campus, University of Colorado, examined whether outpatient palliative care leads to better improvements in Parkinson disease patient and caregiver outcomes, compared to standard care.

Patients suffering from Parkinson disease and other related disorders often face declining quality of life outcomes. While interest in palliative care has grown in recent years, few studies have been conducted to support the effectiveness of the treatment.

The randomized clinical trial included 210 patients with Parkinson disease and related disorders, as well as 175 caregivers at 3 academic tertiary care centers between November 2015 and September 2017. There was also a year of follow-up conducted.

Patients were randomly assigned to receive either standard care with integrated palliative care or standard care alone.

Outpatient integrated palliative care was administered by a neurologist, social work, chaplain, and nurse using palliative care checklists, with the guidance and selective involvement of a palliative medicine specialists. Standard care was provided by a neurologist and primary care practitioner.

The investigators sought primary outcomes of the differences in patient quality of life, measured by the Quality of Life in Alzheimer Disease scale and caregiver burden, measured by the Zarit Burden Interview, between the 2 different care groups at 6 months.

Patients receiving palliative care intervention had better quality of life scores (mean [SD], .66 [5.5] improvement vs .84 [4.2] worsening; treatment effect estimate, 1.87; 95% CI, .47-3.27; P = .009) than the standard care group.

There were also no significant differences in caregiver burden between the 2 groups (mean [SD], 2.3 [5.0] improvement vs 1.2 [5.6] improvement in the standard care group; treatment effect estimate, −1.62; 95% CI, −3.32-.09; P = .06).

There were other significant differences favoring the palliative care intervention included nonmotor symptom burden, motor symptom severity, completion of advance directives, caregiver anxiety, and caregiver burden at 12 months.

There were no outcomes that favored standard care alone and secondary analysis revealed that the benefits were greater for patients with higher palliative care needs.

“Outpatient [palliative care] is associated with benefits among patients with [Parkinson disease or related disorders] compared with standard care alone,” the authors wrote. “The lack of diversity and implementation of [palliative care] at experienced centers suggests a need for implementation research in other populations and care settings.”

Palliative care is a method of care aiming to improve the quality of life of patients, while reducing suffering in individuals with serious illness by addressing medical symptoms, psychosocial issues, and advanced care planning.

While this type of care has generally been associated with hospice care and cancer, it has potential to expand substantial to noncancer populations, delivery in outpatient settings, and delivery by individuals not specializing in palliative medicine or by disease-specific clinics including palliative medicine input.

The study, “Comparison of Integrated Outpatient Palliative Care With Standard Care in Patients With Parkinson Disease and Related Disorders,” was published online in JAMA Neurology.